Sunday, September 27, 2009

Okay, Grumpy fans. Put your books away and get out a #2 pencil. We're having another pop quiz. Mr. Knucklehead, please put away the issue of Boy's Life. We can all see you're hiding your mom's new Cosmo behind it.

Everyone ready? Good.

Question: You're a nurse at a major hospital. Your patient's white cell count (WBC) jumped from a horribly abnormal 44 yesterday to a frighteningly abnormal 79 this morning.

Do you call:

A. The hematologist treating the patient's bone marrow disorder.

B. The cardiologist following the patient's pacemaker.

C. The neurologist evaluating the patient's imbalance.

If you answered C, thank you for waking me up this morning. I greatly enjoyed your reasoning of "I called you because your name was the first one listed alphabetically."

How about the nurse contacting the intern/resident looking after the patient who might be able to review the chart, examine the patient, arrange for appropriate further investigations and then contact an attending for a sensible discussion about doing what is best for the patient? Or am I grossly mistaken about the respective roles of doctors and nurses in secondary & tertiary care?

How about no one? I didn't really see a WBC jumping from one high level to another, while staying below critically high (100k) to be something that can't wait a few hours til they ALL come look at labs anyways.

Poor Dr Grumpy... you really need to keep a preposterous list of responses next to your phone for these late night calls: > Yes nurse, but not during pringled calf season. Then it is reverse alphabetical order. Sorry.> Cyrillic or Roman alphabet?? You got it all wrong...> Was that YOUR medical specialty-- the alphabet?

In my (teaching) hospital we (the RNs) call the admitting team. Actually in both hospitals I work in, one in the ER and the other in a neurosurgery/trauma unit, we call the primary team. They are the only ones who write orders all the other teams simply consult and write recommendations.

So...even though it would make sense to call the hematologist we'd call you if the patient was admitted to the neurology service as the primary.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.